Don’t Follow Dogma; Follow Evidence You’ve been told for decades to eat less salt. This recommendation is dangerously outdated advice. These long-standing nutritional dogmas fall flat under the withering light of evidence-based medicine. The salt–blood pressure connection was oversimplified, and you’ve been suffering the consequences. For the sake of your magnesium levels, think twice before restricting your salt intake. Eating more salt might help prevent magnesium deficiency to potentially reduce the risk of high blood pressure and cardiovascular disease. It’s time you stopped fearing the salt shaker and started embracing your salt hunger; your magnesium levels might depend on it.
As we look back over the last forty years, it’s hard to understand how we could have been as gullible as we’ve been. We believed that fat—more
specifically saturated fat, which is the fat found primarily in animal foods— increased cholesterol and caused heart disease. To make matters worse, we were led to believe that we needed to switch to “heart-healthy” vegetable oils, like cottonseed, corn, safflower, and soy oils. Recent evidence suggests we were making a deal with the devil when we made this switch. The industrially processed seed oils were much worse than fat from animal sources. It was all a terrible mistake that began with Crisco.1
The Rise of Seed Oils Cotton plantations were established in the United States as early as 1736 to cultivate cotton for fabric. Before this, cotton was largely an ornamental plant. At first, most cotton was home-spun into garments, but the success of the crop meant that some could be exported to England. A modest 600 pounds of cotton was produced in 1784; by 1790, that amount grew to more than 200,000 pounds. When Eli Whitney invented the cotton gin in 1793, the amount of cotton produced increased to a staggering 40,000,000 pounds. But cotton is two crops: the fiber and the seed. The by-product of every 100 pounds of fiber produced from cotton was 162 pounds of cotton seeds, which were largely useless. Farmers needed only 5 percent of this seed for planting. Farmers could use some seed for livestock feed, but the remainder was still a mountain of garbage. What could farmers do with this garbage? In most cases, they left it to rot or illegally dumped it into rivers. It was toxic waste. Meanwhile, in the 1820s and 1830s, a growing population in the United States resulted in an increased demand for oil for cooking and lighting. A decreased supply of whale oil for lamps meant that prices rose steeply. Enterprising entrepreneurs tried to crush the worthless cotton seeds to extract the oil, but it was not until the 1850s that the technology matured to the point that commercial production could commence. Then in 1859 something happened that would transform the modern world. Edwin Drake, who was known as Colonel Drake, struck oil in Pennsylvania and introduced a massive supply of fossil fuels to the market. Before long, the demand for cottonseed oil for lighting had completely evaporated, and cottonseeds were, once again, toxic waste. Now cottonseed processors had lots of cottonseed oil on hand, but no demand. One solution was to add it illicitly to animal fats and lards. There was no evidence that this was in any way safe for human consumption. (We don’t eat our cotton T-shirts, after all.) Cottonseed oil, which is light in flavor and slightly yellow, also was blended with olive oil to reduce costs.
Italy, aghast at this crime against their culinary traditions, banned adulterated American olive oil in 1883. The Procter & Gamble company used cottonseed oil to manufacture candles and soap, but the company soon discovered that they could use a chemical process to partially hydrogenate cottonseed oil into a solid fat that resembled lard. This process produced what we now call trans fats. The hydrogenation made this product extremely versatile in the kitchen and gave it a longer shelf life, although nobody knew that they were putting something into their mouths that was formerly considered toxic waste. This new solid vegetable oil made pastries, such as pie crusts, flakier. Because the hydrogenation gave the oil a longer shelf life, it could sit on a grocery store shelf for months without going rancid. It was smooth and creamy and as useful as animal fats in cooking for a fraction of the cost. Was it healthy? Nobody knew, and nobody cared. This new-fangled semisolid fat resembled food, so the manufacturer marketed it as food. The company called this revolutionary new Franken-product Crisco, which stood for crystallized cottonseed oil. Crisco was skillfully marketed as a less expensive alternative to lard. In 1911, Procter & Gamble launched a brilliant campaign to put Crisco into every American household. They produced a recipe book (and all the recipes used Crisco, of course) and gave it away. This type of marketing campaign was unheard of at the time. Advertisements of that era also proclaimed that Crisco was easier to digest, cheaper, and healthier than lard because it was produced from plants. The ads neglected to mention that cottonseeds were essentially garbage. Over the next three decades, Crisco and other cottonseed oils dominated the kitchens of America, displacing lard. By the 1950s, cottonseed oil was becoming expensive, so Procter & Gamble again turned to a cheaper alternative, soybean oil. The soybean had taken an improbable route to the American kitchen. Originally from Asia, where they had been domesticated in China as far back as 7000 BC, soybeans were introduced to North America in 1765. Soybeans are approximately 18 percent oil and 38 percent protein, which makes them ideal as food for livestock or industrial purposes (such as paint and engine lubricants).
Americans ate almost no tofu before World War II, so few soybeans made it into the American diet. Things began to change during the Great Depression when large areas of the United States were affected by severe drought. Farmers discovered that soybeans could help regenerate the soil through their ability to fix the nitrogen levels of the soil. It turns out that the great American Plains were ideal for growing soybeans, so they quickly became the second most lucrative crop, just behind corn. Meanwhile, in 1924, the American Heart Association (AHA) was formed. At its inception, the AHA was not the powerful behemoth it is today; it was just a collection of heart specialists who occasionally met to discuss professional matters. In 1948, this sleepy group of cardiologists was transformed by a $1.7 million donation from Procter & Gamble (maker of hydrogenated trans fat–laden Crisco), and the war to replace animal fats with vegetable oils was on. By the 1960s and 1970s, in a charge led by Ancel Keys, experts proclaimed the new dietary villain to be saturated fats, the type found most frequently in animal foods like meat and dairy. The AHA wrote the world’s first official dietary recommendations in 1961 recommending that people “reduce [the] intake of total fat, saturated fat and cholesterol [and] increase [the] intake of polyunsaturated fat.” In other words, people were encouraged to avoid animal fat and eat “heart-healthy” vegetable oils, which were high in polyunsaturated fats, like Crisco. This advice carried forward and was integrated into the influential 1977 Dietary Guidelines for Americans. The AHA threw its now considerable influence into making sure that Americans ate less animal fat and less saturated fat. The Center for Science in the Public Interest (CSPI), for example, declared the switch from beef tallow and other saturated fats to trans-fat-laden partially hydrogenated oils “a great boon to Americans’ arteries.”2 Don’t eat butter, they said. Instead, replace it with the partially hydrogenated vegetable oil (read: trans fats) known as margarine. According to the CSPI, that edible tub of plastic was much healthier than the butter that humans had been consuming for at least 3,000 years, they said. Even as late as 1990, as the mountain of evidence was piling up that trans fats were supremely dangerous, the CSPI refused to acknowledge the dangers of trans fats. The group’s famous bottom line was,
“Trans, shmans. You should eat less fat.”3 Hydrogenation has many benefits for food manufacturers, including low cost and increased shelf life, but improved human health is not one of them. Ironically, these trans fat–laden margarines that the CSPI was promoting in place of animal fats4 are more harmful than the fats they replace.5 In 1994, the CSPI struck fear into moviegoers’ hearts with a brilliant scare campaign. At that time, movie popcorn was popped in coconut oil, which was largely saturated fat. The CSPI declared that a medium-size bag of movie popcorn had more “fat than a breakfast of bacon and eggs, a Big Mac and fries and a steak dinner combined.”6 Movie popcorn sales plunged, and theaters raced to replace their coconut oil with partially hydrogenated vegetable oils. Yes, trans fats. Additionally, the war to rid the American public of animal fat spilled over to beef tallow, which was the secret ingredient of McDonald’s french fries. The fear of “artery-clogging” saturated fat resulted in the switch to—you guessed it—partially hydrogenated vegetable oils. But the story was not yet done. By the 1990s, the trans fats that the AHA and the CSPI told us were supposed to be so healthy for us were implicated as major risk factors for heart disease. New studies indicated that trans fats almost doubled the risk of heart disease for every 2 percent increase in trans fat calories.7 By some estimates, trans fats from partially hydrogenated vegetable oils were responsible for 100,000 deaths in the United States.8 Yes, 100,000 deaths. The very “heart-healthy” foods the AHA recommended were giving us heart attacks. Oh, the irony. By 2015, the U.S. Food and Drug Administration (FDA) removed partially hydrogenated oils from the list of Generally Recognized as Safe human foods. Yes, the AHA had been telling us to eat poison for decades. The very “heart-healthy” foods the AHA recommended were giving us heart attacks. Industrial seed oils, such as cottonseed, are high in the omega-6 fat linoleic acid. Linoleic acid is called the parent omega-6 fat because other omega-6 fats, such as gamma linolenic acid (GLA) and arachidonic acid,
are formed from it. During Paleolithic times (2.6 million years ago until 10,000 years ago), linoleic acid came from whole foods, such as eggs, nuts, and seeds; humans would not have gotten any omega-6 from industrial seed oils. However, Crisco introduced an isolated and adulterated type of linoleic acid into our diet—one that was cheap, convenient, and highly damaging to our arteries. Since 1911, linoleic acid consumption has dramatically increased, and the source is one that humans had never consumed before. These omega-6 seed oils are now ubiquitous in nearly all manufactured foods, shelves of plastic bottles of seed oils line grocery store aisles. Unfortunately, these chemically unstable oils are highly susceptible to oxidation by heat, light, and air, and the oils get exposure to all three during their processing. Thus, although linoleic acid that comes from whole foods might be beneficial, the adulterated linoleic acid found in industrial seed oils is not. For a deeper dive on this topic, check out Dr. DiNicolantonio’s book Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health. So how do we know which are healthy fats and which are unhealthy fats? Unsurprisingly, natural fats, whether they come from animal (meat, dairy) or plant sources (olive, avocado, nut) are generally healthy. Highly processed, industrial seed oils and artificially hydrogenated trans fats are unhealthy. Let’s face it; we ate vegetable oils because they were cheap, not because they were healthy. Let’s dig in to more details.
Basic Facts on Fats Dietary fats are generally divided into two types: saturated and unsaturated (which includes monounsaturated and polyunsaturated). A saturated fat is so named because its carbon “backbone” is saturated, or full with, hydrogen atoms, and it can’t accept any more. A monounsaturated fat, such as the oleic acid in olive oil, has space to accept one extra hydrogen (mono means one), and polyunsaturated fats can accept many hydrogens (poly means many). Fig. 11.1: The different types of fats All natural sources of fat contain a mixture of all types of fat—saturated, monounsaturated, and polyunsaturated. However, the proportions vary. Animal sources, such as dairy or meat contain mainly saturated fats, whereas seed oils contain largely polyunsaturated fats of the omega-6 variety. Natural polyunsaturated fats, such as those in flaxseed and fatty fish, contain omega-3 fatty acids, including alpha-linolenic acid (ALA)
(which is highly concentrated in flax) and docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) (which are highly concentrated in seafood). Although we tend to think of animal fats as saturated, bacon fat contains more oleic acid (a monounsaturated fat high in olive oil) than saturated fat. Chicken fat is approximately 50 percent monounsaturated compared to 30 percent saturated fat. Healthy olive oil contains almost 14 percent saturated fats. The highest concentrations of saturated fats are not in animal products but plant products; coconut oil is more than 90 percent saturated fat.
Fats to Avoid: Trans Fats and Industrial Seed Oils What’s shocking is that the very fats you’ve heard for decades are heart healthy (such as the trans fats and seed oils in Crisco) are the fats you want to avoid. In this section, we explain the harms of these fats, the studies, and the history of how you have been fed a big fat lie for more than a century. INDUSTRIAL TRANS FATS The recommendation to avoid trans fats is no longer controversial. The name derives from the alignment of the double bond found in many vegetable oils. The natural configuration of these fats is altered by artificial hydrogenation (adding hydrogen to unsaturated fats) that results in an unnatural configuration known as trans. Interestingly, natural trans fats found in ruminants such as sheep and goats do not appear to increase the risk of heart disease.9 Most nations of the world have either banned from use or are in the process of eliminating trans fats from their diet. In 2003, Denmark passed legislation that no more than 2 percent of fats and oils in any food product can contain trans fats.10 As of June 18, 2018, the U.S. Food and Drug Administration ban on all trans fats from American restaurants and grocery store food items took effect. Canadians found their foods free of this Franken-fat by September 15, 2018. The World Health Organization issued a plan in 2018 to eliminate trans fats worldwide by 2023. Tom Frieden, a former head of the U.S. Centers for Disease Control said, “Trans fat is an unnecessary toxic chemical that kills, and there’s no reason people around the world should continue to be exposed.”11 VEGETABLE OILS
Vegetable oils, rich in omega-6, reduce cholesterol, so it was assumed that this reduction automatically translated into less heart disease. The human body can synthesize most of the different types of fats necessary for good health with two major exceptions—the essential fatty acids linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid)—that we must obtain from the diet. Deficiency of either essential fatty acid results in disease. However, the ratio of omega-3 to omega-6 (see the table) is just as important because these two compete with each other for incorporation into human tissues and for the same rate-limiting enzymes. The Omega-6-to-3 Ratio* of Common Oils Dietary Source Omega-6-to-3 Ratio Grapeseed 696 Sesame 138 Safflower 78 Sunflower 68 Cottonseed 54 Corn 46 Peanut 32 Olive 13 Avocado 13 Soybean 7 Hemp seed 3 Chia seed 0.33 Flaxseed 0.27 Canola 0.2 * Table from Superfuel by Dr. James DiNicolantonio and Dr. Joseph Mercola. Copyright © 2018 by Dr. James DiNicolantonio and Dr. Joseph Mercola. Reprinted with permission of Hay House, Inc., Carlsbad, CA. The omega-6-to-3 ratio refers to LA/ALA.
It is estimated that an ancestral diet provided roughly equal amounts of omega-3 and omega-6 fatty acids. Plant omega-3 (ALA) is in foods like nuts, seeds, and beans, whereas marine omega-3 (EPA/DHA) is in seafood. Vegetable oils are almost purely omega-6. The dominance of industrial seed oils in the American diet has led to estimates that we consume ten to twenty-five times as much omega-6 as omega-3. The AHA has long recommended replacing saturated fats with polyunsaturated fatty acids (PUFAs) like vegetable oil to reduce the risk of heart disease and death. However, recent trials have concluded that this is exactly wrong. When the advice originated in the 1960s, there was no distinction made between omega-3 and omega-6 fatty acids. Although both are PUFAs, their health effects are widely divergent. We have considerable evidence that the omega-3 fatty acids, such as DHA and EPA in fish oil, improve cardiovascular health. In contrast, overconsumption of the highly inflammatory omega-6 fatty acids in seed oils significantly worsen cardiovascular health. The Sydney Diet Heart Study (SDHS) was a randomized controlled trial in which researchers replaced saturated fats with safflower oil, a concentrated source of omega-6.13 This substitution was exactly the sort of thing the AHA had been advocating for years. Replace your butter with vegetable oil–based margarine. Those unfortunate enough to have followed this conventional advice in the SDHS suffered a 62 percent higher risk of death. The studies were showing that the “heart-healthy” seed oils were actually lethal. The dangers of eating excessive omega-6 have long hidden behind some of the beneficial effects of omega-3. When the two fatty acids were analyzed separately, the dangers became obvious. In trials that included both omega-3 and omega-6, there was approximately a 20 percent reduction in death compared to saturated fat plus trans fat. However, trials that emphasized only omega-6, thereby raising the omega-6 to omega-3 ratio dangerously high, found a 33 percent increase in deaths, which was soon corroborated by other analyses (see Figure 11.2).14
Fig. 11.2 The harm from consuming industrial omega-6 seed oils might be due to an increase in oxidized linoleic acid metabolites (OXLAMs), which increase the susceptibility of LDL to oxidize, stimulate cancer, and lower HDL (high-density lipoproteins).15 We recommend that you completely avoid consuming industrial seed oils. However, the moderate intake of linoleic acid from natural sources such as nuts, seeds, eggs, or chicken is safe because the linoleic acid from whole foods are protected from oxidation. Unfortunately, the news would get much, much worse. The most rigorous study of changing our dietary fat from natural fats to industrial seed oils was done in the 1960s and 1970s. However, the results were suppressed and not fully available until 201616 after the original researcher had died, and other researchers retrieved the data from his son’s basement to complete the analysis. In the study, the researchers replaced the natural saturated fats in the food with vegetable oils. The researchers compared findings for the test group to a separate group that was eating the usual diet. This switch, of
course, falls directly in line with the dietary advice the AHA has given for the past forty years without providing any proof that the substitution was beneficial. This study, which is known as the Minnesota Coronary Experiment, began with great promise as the vegetable oil group had lower blood cholesterols as expected. There was also a significant difference in mortality, but, in this case, the news was not good. Switching to vegetable oils increased the risk of death by a staggering 22 percent, and it was worse for patients older than 65. Making the switch isn’t just bad; it’s catastrophic. The precise advice that governments around the world had been handing out to replace natural saturated fats with industrial seed oils high in omega6 was exactly the opposite of what it should have been. We could hardly have done worse if we tried. Replacing natural foods like butter, cream, and meat that humans had been eating for millennia with industrially processed oil from garbage (cottonseed) is harmful. Vegetable oils were made to be cheap, not healthy.
Saturated Fats: PURE Study It is somewhat counter-intuitive that saturated fats should have ever been considered more harmful than other fats. Unsaturated fats have multiple double bonds that enable them to accept other molecules, such as hydrogen. The result is that unsaturated fats are more chemically reactive than saturated fats that don’t have these double bonds. When PUFAs like vegetable oil are left alone for too long, they become oxidized and rancid. Saturated fats, like butter, are far less likely to suffer this problem, as they are more chemically stable. Hydrogenation can artificially change a PUFA into a saturated fat to create the Franken-fat nightmare of trans fats. We don’t want our cells becoming rancid from the fats oxidizing inside our body, so if saturated fats are more stable, wouldn’t consuming more saturated fat be good? The answer is yes. In 2014, Dr. Dariush Mozaffarian, dean of Tufts University’s Friedman School of Nutritional Science and Policy, did a thorough review of all available literature. He found that eating more saturated fats did not increase the risk of heart disease. 17 This finding closely echoes the findings from a 2010 analysis done by Dr. Ronald Krauss, director of atherosclerosis research at the Children’s Hospital Oakland Research Institute, and Dr. Frank Hu from Harvard. Their analysis showed that eating more saturated fats was not associated with more heart disease, and paradoxically, it might be preventative for stroke.18 In 2017, Dr. Salim Yusuf performed the most comprehensive nutritional survey yet done: the Prospective Urban Rural Epidemiological (PURE) study. It spans eighteen countries and five continents; it followed more than 135,000 people for an average of 7.4 years. Given the overwhelming importance of diet and heart disease, it was vital to have rigorous evidence upon which to base national guidelines. The PURE study showed eating more total or saturated fat decreased the risk of heart disease and death (see Figure 11.3).19 Those subjects who ate the most fat had a 23 percent reduction in risk of death compared to those who ate the least fat, with similar results for saturated fat. The risk of heart
disease was also 30 percent lower. The saturated fats that we had all feared as the cause of heart attacks were protective. The widely sanctioned and government-approved dietary guidelines to reduce total and saturated fats in our diets were completely divorced from reality. There was, and still is, no reason to avoid natural fats and saturated fats. Eating a high-carbohydrate diet, as recommended originally in the 1977 Dietary Goals for the United States was also super harmful. In the PURE study, a high-carbohydrate diet was associated with a 28 percent increased risk of death and heart disease. Ironically, the advice for Americans to consume 55 to 60 percent of their calories from carbohydrates was the precise amount from this study that was the most lethal. The original USDA Food Pyramid made no distinction between processed and unprocessed carbohydrates, so the diet of Americans relied heavily upon the highly refined carbohydrates, like white bread and pasta, that were the most problematic.
Fig. 11.3: Decreased mortality with increasing saturated fat intake
Good Fats: Monounsaturated Replacing saturated with polyunsaturated fats was not good. But what about using monounsaturated fatty acids (MUFAs)? Most studies of MUFAs are problematic because of confounding by the variations in carbohydrate intake.20 The Kanwu study shows that MUFA21 improved insulin sensitivity in those taking a high-carbohydrate diet. Switching patients from saturated fat (milk, butter, cheese, and fatty meat) to MUFA (olive oil, nuts, and avocados) resulted in slightly more weight loss, increased energy expenditure, and lower blood pressure despite equal caloric intake.22 More importantly, the MUFA-rich diet improved the more dangerous fat around the abdomen—visceral fat. In other studies, the saturated fat palm oil raised insulin and lowered energy expenditure when added to a diet high in sugar. 23 The MUFA oleic acid, on the other hand, showed a slight increase in daily energy expenditure.24 Eating more monounsaturated fats might give you more wiggle room to eat more carbohydrates without becoming insulin resistant or gaining weight. Perhaps this is why many people living in the Mediterranean stay slim and healthy while enjoying bread and pasta. First, they enjoy these foods without gorging on them with bottomless bowls and multiple refills. Second, the high-carb foods often are accompanied by a generous drizzle of olive oil. A large analysis of fifty epidemiological and randomized controlled studies encompassing more than 500,000 people found that adherence to a Mediterranean diet can improve waist circumference, HDL, triglycerides, blood pressure, and blood glucose levels.25 Oleic acid (the predominant fat in olive oil) has a greater oxidation rate than stearic acid (a saturated fat found in beef and chocolate).26 The result is that it liberates more energy, which increases satiety and reduces subsequent food intake. It also increases fat burning at the cellular level27 and requires more energy for digestion.28 These things are true even for obese post-menopausal women, a group that has a notoriously difficult time losing weight.29 Switching from cream to olive oil allowed these women to
use more fat for cellular energy rather than carbohydrate. If you want to lose body fat, you’ve got to use body fat, not carbohydrate. Strategic fats for a higher carb diet include more nuts, olive oil, and avocados, and less fatty meat and full-fat dairy (cheese, milk, butter). If you do follow a low-carb diet and the occasional “cheat day” sneaks in, it might be better to try to get fats from monounsaturated sources than from saturated sources. (Skip the meat-lovers pizza and opt for sushi, with lots of avocado along with the rice.) Natural saturated fats are fine, but for weight loss, consider replacing them with monounsaturated fat, especially if you favor a more moderate carb intake rather than a low-carb diet. The Benefits of Consuming Less Saturated Fat and More Monounsaturated Fat The following are some effects of consuming less saturated fat and more monounsaturated fat for those consuming a diet moderate to high in carbohydrates:30 • Greater weight loss and fat loss
• Less loss of muscle and lean tissue • Reduced blood pressure • Greater post-meal fat oxidation (burning fat rather than carbohydrate) • Lower post-meal triglycerides • Higher post-meal HDL
Medium-Chain Triglycerides and Coconut Oil Coconut oil is rich in the medium-chain-length saturated fatty acids lauric acid and myristic acid. Most dietary fats are composed of carbon chains that have twelve to twenty-two carbons. Medium-chain triglycerides (MCTs) have only six to twelve carbons, and this shorter length might provide some health benefits. Coconut oil has MCTs; other sources might include palm kernel oil, butter, and whole milk. The shorter chain length makes it possible for the body to absorb MCTs more rapidly, so they’re quickly converted to ketones and metabolized for fuel. Technically speaking, MCTs are absorbed directly into the portal circulation that goes from the intestines to the liver. The lymphatic system absorbs longer-chain fatty acids into the blood; from there, the fatty acids go to the fat cells for storage, so much of it never makes it to the liver. In the liver, MCTs cross the mitochondrial membrane quickly (mitochondria are the power-producing parts of cells), and carnitine doesn’t need to be present for this to happen. In short, MCTs go directly to the liver, where they are metabolized much more quickly into energy. This accelerated metabolic conversion into fuel means that potentially less is stored as body fat and more is burned for fuel. Coconut oil does raise total cholesterol, but it preferentially increases HDL, the “good” cholesterol, which explains some of its reported heart benefits.31 And “virgin” coconut oil, which is similar to virgin olive oil, is even healthier because it’s extracted solely through mechanical means without heat or chemicals and retains all of the bioactive polyphenols typically lost in refinement.32 Organic Traditions makes a great organic raw coconut oil. Human studies using MCTs show some promising results, including greater weight loss compared to olive oil33 and longer-chained saturated fats.34 The greater weight loss may be attributable to appetite suppression or increased energy expenditure. Fast conversion of MCTs to energy activates
satiety mechanisms to stop eating, which has huge significance in weight loss efforts. High MCT intake led to significantly lower overall calorie consumption—in one study, an average of 256 fewer calories per day, 35 and 41 to 169 calories per day in another study. 36 MCT oil might increase energy expenditure when it’s substituted for other oils.37 Dr. Marie-Pierre St-Onge, an associate professor of nutrition at Cornell University Medical School who has been studying MCTs for almost two decades, says, “Coconut oil has a higher proportion of medium-chain triglycerides than most other fats or oils, and my research showed eating medium-chain triglycerides may increase the rate of metabolism more than eating long-chain triglycerides.”38 A diet with 30 grams of MCTs increased twenty-four-hour energy expenditure by 114 calories.39 Although these overall effects are relatively small, the combination of increased energy expenditure with decreased appetite over long periods might hold significant benefits. MCTs lack the polyphenols found in many foods high in MUFA (such as avocados, olives, and nuts). However, coconut oil significantly raises HDL. Traditional populations in the South Pacific that subsisted on large amounts of coconuts, loaded with coconut oil, maintained excellent health for generations. The traditional foods on the islands of Kitava, Trobriand Islands, and Papua New Guinea included roots, fish, and coconut. Studies of this diet found the “apparent absence of stroke and ischaemic heart disease.”40 A high intake of the saturated fats in coconut oil did not “clog” arteries. Instead, there was virtually no heart disease at all. The Tokelau migrant study demonstrates once again the potential benefits of coconut oil.41 The small South Pacific island of Tokelau lies northeast of New Zealand, and for generations the locals subsisted on fish, breadfruit, and coconut. It was estimated that 70 percent of their calories were derived from coconut, so their diet was extremely high in saturated fat—almost 50 percent. Early descriptions of their health noted low levels of high blood pressure, heart disease, obesity, and diabetes. In 1966, a tropical cyclone forced the evacuation of a significant portion of the population to New Zealand. The emigration forced by the cyclone provided a unique opportunity to study the effects of changing to a typical Western diet, which
was higher in sugar and refined carbohydrates and much lower in saturated fat. The news was not good. In a comparison of the Tokelauan emigrants and those who stayed on the island, the average weight of male emigrants increased by twenty to thirty pounds over the ensuing decade. Diabetes more than doubled in the population. Blood pressure rose by an average of 7.2 mmHg systolic and 8.1 mmHg diastolic, and gout increased. Replacing the traditional diet heavy in coconut and coconut oil with a Western diet was hugely detrimental to the Tokelauans’ health.
Full-Fat Dairy For years, we’ve been told to eat low-fat dairy or drink skim milk with the assumption that the milk fat, which is highly saturated, was detrimental to our heart health. This assertion is a direct contradiction of the wisdom of the previous millennia during which dairy was prized specifically for its high fat content. In English, there are many phrases like: • The cream always rises to the top. • This is the cream of the crop. • You’re skimming off the top. All of these sayings have the same connotation: The cream, the fattiest part of the milk, is also the most desirable. With the heavy emphasis on eating low-fat dairy, you might think that many scientific studies had shown that dairy fat was unhealthy and that reducing milk fat was healthy. You might also be wrong. No evidence exists to prove that eating high-fat dairy causes heart disease. Modern research exonerates dairy fat, this former villain.42 A meticulous twenty-two-year follow-up of patients that measured blood markers of dairy fat found that eating dairy fat was not related in any way to the risk of heart disease or death. The study built upon a previous 2014 study that concluded there was no increased risk of stroke.43 Lead author Dr. Marcia Otto pointed out that “the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke.”44 Yes, eating full-fat dairy was healthy, not harmful. A 2013 analysis suggests that dairy fat also might be protective against the development of type 2 diabetes, which is a growing epidemic worldwide.45
So, there is no longer a reason to be scared of eating full-fat dairy. Indeed, Dr. Arne Astrup, director of the Department of Nutrition at the University of Copenhagen, wrote in 2014 an article titled “A Changing View on Saturated Fatty Acids and Dairy: From Enemy to Friend.”46 This recent evidence shows why Time magazine proclaimed in 2016 that “butter is back.”
Going Nuts In the late 1990s, experts discouraged us from eating nuts largely because they are generally high in fat. Because all fats were considered bad, high-fat foods like nuts and avocados were also considered very unhealthy. But several large studies gradually pointed out the fact that eating nuts was associated with significant heart protection. This finding has now been replicated many times,47 and the advice to eat more nuts is now widely accepted. In this context, nuts include true tree nuts (almonds, hazelnuts, walnuts, and so on) and peanuts, which are a form of legume. Nuts contain primarily oleic acid, the same unsaturated fat found in olive oil, but they also contain plenty of fiber, protein, minerals, and polyphenols. Eating more nuts has been linked to a 13 percent reduced risk of type 2 diabetes, a lower risk of high blood pressure, and lower LDL cholesterol. These findings have prompted the AHA to recommend eating more nuts and seeds to reduce the risk of heart disease.48 For each daily serving of nuts, studies estimate a reduction in risk of cardiovascular disease of 28 percent. Eating organic nuts, such as almonds, cashews, and hazelnuts, is an even better option. (Organic Traditions, which you can find at http://organictraditions.com, is a good source for organic nuts.) Eating nuts was associated with significant heart protection.
Extra-Virgin Olive Oil: Going the “Extra” Mile Extra-virgin olive oil (EVOO) and pure olive oil are both made from olives, but the two manufacturing processes are completely different. EVOO is an unrefined oil that’s not treated with any chemical processes or heat. The oil is made by grinding olives into a paste and then cold-pressing them to extract the oil. EVOO is generally the highest-quality oil you can buy, and it has a price to match. The remaining paste still contains oil, so it can be treated with chemical solvents and heat to extract the remaining oil. This output becomes “pure” olive oil, which is generally cheaper than EVOO but is a refined oil that’s of a lesser quality. Extra-virgin olive oil is healthier than virgin olive oil because of its higher polyphenol content. A randomized, cross-over, controlled trial found that increasing the polyphenol content linearly increased the HDL and decreased the oxidized-LDL (the “bad” cholesterol). The authors of the study concluded, “Olive oil is more than a monounsaturated fat. Its phenolic content can also provide benefits for plasma lipid levels and oxidative damage.”49 The phenolic compounds in EVOO have been noted to inhibit the oxidation of LDL, the process that makes LDL cholesterol so dangerous for the development of heart disease.50 A study has shown that 50 grams of olive oil (just under 2 ounces) per day for just two weeks reduces LDL oxidation by 73 percent and macrophage uptake of LDL by 61 percent.51 These numbers suggest that olive oil, especially EVOO, might reduce atherosclerosis. Also, human studies show that EVOO lowers inflammation,52 the “stickiness” of blood,53 DNA damage,54 oxidized LDL, and blood pressure, and it improves endothelial function.55 For this reason, EVOO—especially a raw, ice-pressed organic olive oil such as Organic Traditions olive oil—is worth the extra mile for our health.
The Benefits of Marine Omega-3s Consuming high amounts of marine omega-3s EPA and DHA has many health benefits, including fewer cardiovascular events and death.56 Taking just 1 gram of EPA/DHA after a heart attack can reduce overall mortality, sudden cardiac death, and death. However, higher doses of EPA and DHA (3 to 4 grams per day) can reduce blood pressure, lower triglycerides, and stabilize atherosclerotic plaques.57 Long-chain omega-3 fats reduce the risk for obesity by increasing basal metabolic rate and muscle protein synthesis while reducing muscle breakdown.58 Fatty fish, such as salmon or sardines, are great sources of marine omega-3 fatty acids. However, there may be an even better source: krill oil. Recommendations for EPA/DHA Supplementation For maintenance of health and those with health conditions: We recommend consuming 3 to 4 grams of EPA/DHA per day from quality sourced wild seafood or a high-quality fish oil or algal oil supplement plus 3 to 4 grams of krill oil.
Krill Oil Krill are tiny crustaceans (similar to shrimp) that live in the Arctic, Antarctic, and Pacific Oceans. Because krill are so small, they experience less heavy metal contamination than fish. The omega-3 fatty acids from krill provide enhanced absorption and penetration into the brain. A 1-gram dose of Neptune Krill Oil provides EPA/DHA (240 milligrams), vitamin A (100 IU), vitamin E (0.5 IU), phospholipids (400 milligrams), astaxanthin (1.5 milligrams), and choline (74 milligrams).59 Krill oil improves arthritis,60 premenstrual syndrome, breast tenderness, and joint pain.61 Krill oil at 1 to 3 grams per day is also more effective for reducing blood glucose, total cholesterol, and triglycerides and increasing HDL compared to fish oil and placebo.62 Think of krill oil as “super omega3” as it also contains astaxanthin, a highly potent antioxidant. Astaxanthin is unique because it can span across the entire lipid bilayer of the cell membrane and act as both a water- and fat-soluble antioxidant. Thus, astaxanthin prevents oxidative damage on the outside of the cell membrane and from the inside. Prehistoric humans obtained “marine” omega-3s by consuming the brains of kills on the African Savannah.63 Ounce for ounce, brain tissue is higher in DHA than salmon.64 This source was more easily absorbed65 and provided early humans with a unique “brain-DHA advantage.” Eating brain is no longer routine, so supplementing with krill oil is the next best thing. Astaxanthin may help prevent the highly susceptible DHA in your brain from oxidizing, as it acts like a highly potent water- and lipid-soluble antioxidant.
The Health Benefits of Krill Oil66 Krill oil is better absorbed and less likely to be oxidized than fish oil. The omega-3s in krill are bound to phospholipids (which they aren’t in fish oil). They can readily cross the blood-brain and blood-retinal barrier and deliver omega-3s into lipid bilayers to get to the sites that need them. Krill oil provides phosphatidylcholine, which may help prevent fatty liver disease and improve cognition. Astaxanthin penetrates skin cells to help prevent ultraviolet damage from sunlight. Krill oil has greater antioxidant capabilities compared to fish oil. It has an oxygen radical absorbance capacity (ORAC) value that is 378 times greater than vitamin A and E 47 times greater than fish oil 34 times greater than CoQ10 6.5 times greater than lycopene Krill has a singlet oxygen quenching capacity that is 6,000 times greater than vitamin C 800 times greater than CoQ10 550 times greater than vitamin E
40 times greater than beta-carotene Unlike fish oil, krill oil has no fishy burp or aftertaste. It improves stiffness due to osteoarthritis. Krill oil decreases C-reactive protein (CRP) by 30 percent Triglycerides by 28 percent LDL cholesterol up to 40 percent It increases HDL cholesterol by 44 to 60 percent. It significantly decreases fasting blood glucose levels by 6 percent. Whereas fish oil decreased pericardial fat (fat around the heart) in rats by 6 percent, krill oil reduced it by 42 percent! In rats, krill oil decreased liver fat by 60 percent, whereas fish oil decreased it only 38 percent.
Making Good Choices About Fats The current classification of fats as saturated, monounsaturated (MUFA), or polyunsaturated (PUFA) is completely useless for understanding fats’ effects on human health. This classification belongs in a chemistry book, not a book on health and longevity. Some fats are healthy (fats contained in whole foods), and some fats are unhealthy (industrially produced trans fats and vegetable oils). Saturated fats can be healthy, such as those found naturally in dairy and coconut oil. Polyunsaturated fats can be healthy (marine omega-3s) or unhealthy (industrial seed oils too high in omega-6 oils). More and more studies are finding the health benefits of monounsaturated fats found in olive oil, nuts, and meat. But artificial monounsaturated trans fats are extremely unhealthy. Knowing whether a fat is saturated or not does not help us understand whether we should eat them. Instead, we can get a good idea of whether a fat is healthy by asking one simple question: Is it a natural fat? Those fats we find in nature, the ones we’ve been consuming as part of the human species for thousands of years, are not likely to be dangerous to our health. There are natural saturated fats (in dairy and coconut), natural monounsaturated fats (in olive oil), and natural polyunsaturated fats (omega-3 and omega-6). Research is now confirming the seemingly obvious notion that eating foods as close to their natural state as possible is healthy. On the flip side are highly processed oils and fats. Trans fats are artificial unsaturated fats that we must avoid at all costs. This is almost universally understood. But avoiding highly processed, highly unnatural vegetable oils is just as important. Were our caveman ancestors opening a jar of sunflower oil to cook with? Or were they eating animal fat? It is the ultimate hubris to believe that humans can cook up an artificial, man-made fat such as vegetable oil that will be healthier than the fats that Mother Nature has made available for us to eat. Corn, for example, is not particularly oily. So, corn may be a natural food, but corn oil is not. It’s important to make sure that you consume healthy fats. These healthy fats, and foods that contain them, include extra-virgin olive oil, long-chain
omega-3s, such as EPA and DHA, which are in seafood as well as fish, algal, and krill oil supplements, and the parent omega-3 fat, ALA, which is in flax and chia seeds. (Organic Traditions has a great variety of these seeds.) Even animal fats, such as butter, cheese, and milk seem harmless, especially when they come from pastured sources. You should avoid harmful fats, such as industrial trans fats and industrial omega-6 seed oils, at all costs.
In 2005, National Geographic writer Dan Buettner used the term Blue Zones to describe certain areas of the world where people lived longer,
healthier lives. The list of Blue Zones includes • Okinawa, Japan • Sardinia, Italy • Loma Linda, California • Nicoya Peninsula, Costa Rica • Ikaria, Greece
People living in these Blue Zone locations reach ages in their nineties, and even live past 100 (to become centenarians), with relatively little agerelated disease. Although these people live throughout the world, with seemingly widely divergent diets and lifestyles, they all share certain characteristics that might help them live longer, fuller lives. These people often smoke less, move more (and at a moderate level), and prioritize family and socializing above all else. Their diet is often, but not always, plant-based, with relatively low protein intake, especially from animals. It is instructive to look a little more closely at the diets of these longevity superstars to learn their secrets.
Okinawa, Japan Across the world, the average number of people who live to be older than 100 is only 6.2 per 100,000. According to their 2017 census, Japan boasted the world’s highest proportion of centenarians at 34.85 per 100,000. However, in 1990, the tiny Japanese prefecture of Okinawa crushed even that number with an astounding 39.5 per 100,000.1 Okinawan men typically live to the age of 84, whereas the women live to an average age of 90 years, even though Okinawa is Japan’s poorest prefecture and has the lowest number of physicians per capita. Citizens suffer small fractions of the rates of diseases that typically kill Westerners: 20 percent the rate of heart disease, breast cancer, and prostate cancer, and less than 50 percent the rate of Alzheimer’s disease.2 Tellingly, the diet in Okinawa has changed significantly in recent years to become more Westernized. By the year 2000, the Okinawan longevity advantage had largely vanished. Nevertheless, good data about the traditional diet of Okinawa can give us clues to their former longevity.
The traditional Okinawan diet contained some meat, particularly pork, along with plenty of plants. The oldest existing record of Japanese diets, which is from 1880, shows that Okinawans got an astounding 93 percent of their calories from the sweet potato.3 They ate just under 40 grams of protein per day—a habit that persisted at least until 1949. Meals consisted of sweet potato, miso soup, and plenty of vegetables for breakfast, lunch, and dinner. The traditional diet of Okinawans was about 80 percent carbohydrates, consisting of sweet potatoes, vegetables, and some grains. Just after World War II, Okinawans got nearly 70 percent of their calories from low-protein, nutrient- and fiber-dense sweet potatoes.4 This diet is virtually the opposite of the Standard American Diet, which is low in nutrients (particularly potassium, magnesium, vitamin C, and carotenoids) and fiber. 5 Along with the ubiquitous sweet potato, other vegetables and legumes made up about 10 percent of the Okinawans’ diet, and rice and other grains were responsible for nearly 20 percent. In 1988, the daily intake of pulses (beans)
was 30 percent above Japan’s national average, and the intake of green and yellow vegetables was 50 percent higher. The Okinawan sweet potato ranges from red to deep yellow due to the high levels of anthocyanin. Both types of sweet potatoes are very high in polyphenols and antioxidants. Okinawa, which is a relatively isolated string of subtropical islands, has two growing seasons, which is favorable for the production of sweet potatoes and fresh vegetables. Rice grew poorly and was supplanted as the staple crop by the sweet potato in the 1600s. Once a month, Okinawans held various festivals where they consumed meat, particularly fish and pork. Historically, meat and fish combined made up just a paltry 1 percent of calories, and dairy products and eggs were rare. The Okinawans’ diet was nearly a vegan diet, and it supplied only about 1,800 calories a day6 (compared to the 2,500 calories the average American consumes). Over time, meat consumption increased. Residents of the coastal areas commonly ate fish; pork was the other common meat. Pigs were “free range,” so they consumed wild plants, but people also fed them leftover vegetables rather than the grains farmers fed to pigs on feedlots in the West. Consequently, the meat from the free-range pigs was higher in omega-3 fatty acids and lower in omega-6 polyunsaturated fatty acids. Sodium intake in the Okinawan diet is high, which is characteristic of all Japanese cuisine. The high levels of sodium come from the common use of soy sauce, miso, salted fish, and pickled vegetables. One unique facet of Okinawan cuisine is the high consumption of the seaweed kombu. Although Japanese cuisine makes use of kombu for flavoring soups, the Okinawans eat large amounts of the seaweed directly. Kombu, which grows in seawater, is high in fiber, minerals, the marine omega-3 fats EPA and DHA, and salt; kombu contains a whopping 840 milligrams of sodium per ounce! The low amount of protein was not detrimental to Okinawans’ health or longevity. Their smaller stature and lower overall muscle mass mean we can’t extrapolate this data to a muscular weight-lifting American, but it suggests that maybe we don’t need as much protein as we once thought, especially if we’re not doing intense resistance exercise.
Meat intake in Okinawa rose steadily in the post-World War II years, and by 1988, it had surpassed the Japanese average. Meat intake averaged 90 grams per person per day with an equal amount of pulses. Thus, the Okinawans did well with both a diet that was very low in protein and one that was relatively high in protein. Most Western cultures have a daily meat intake of more than 200 grams per day. (Note: A gram of meat is not the same as a gram of protein because meat might contain significant fat, depending upon the specific type of meat and cut.) There were other changes in the modern Okinawan diet, too. The intake of pulses and green and yellow vegetables declined to the national average of Japan. The percent of calories from fat rose higher than 30 percent. The group of residents that have westernized their diet the most are younger residents, especially young men. They tend to avoid the traditional champuru dish, which contains meat (typically pork) or tofu that’s stir-fried with vegetables. They also eat less fish than older generations. Residents of Okinawa, like those in most parts of Japan and East Asia, drink copious amounts of tea. The most popular drinks are green tea and kohencha, a semi-fermented tea. In Okinawa, green tea is often scented with jasmine flowers and turmeric in a tea they call shan-pien, which loosely translates to tea with a bit of scent. The average Okinawan drinks at least 2 cups of tea daily.
The Okinawans traditionally follow an ancient Confucian tradition called Hari Hachi Bu. They stop eating before they are full; they only eat until they are no longer hungry. There’s a profound difference between those two states. They deliberately stop eating when they are 80 percent full, a practice that has the same effect as a methodical 20 percent calorie reduction. To be able to stop eating before reaching fullness, Okinawans must practice what people often call mindfulness eating. If you are going to practice Hari Hachi Bu as the Okinawans do, you must constantly think about whether you are full. You can follow some guidelines to make this deliberate calorie restriction easier: • Remember that when you are eating, eat well. • When you are not eating, don’t eat. Never eat mindlessly. Don’t eat in front of the TV. Don’t eat and read. Don’t eat in front of the computer. Concentrate upon what you are eating and enjoy it. • When you are no longer hungry, stop eating. • Eat slowly. Satiety signals in our stomachs take some time to register. If you eat until you are full, you can easily overshoot. Think about the last time you went to a buffet dinner. As you were eating, everything was fine. But after 10 or 15 minutes later, as all the satiety signals start to hit, you feel like you are going to explode. You might even be slightly nauseous. • Use smaller plates or dishes to force yourself to get less food. We tend to eat everything on our plates because that habit has been ingrained into us since childhood. We clean our plates whether we have a lot of food or a little food. If we overfill our plates, we tend to keep eating until we finish everything, regardless of whether we are full. If we instead deliberately underfill our plates, then we can empty our plates without overeating, and
we’re forced to question whether we’re still hungry before reaching for more food. Unfortunately, the longevity advantage of Okinawans is quickly disappearing. After World War II, white bread and white rice started to replace the beloved sweet potato. Younger Okinawans are now eating more American-style fast food than ever, and many have become overweight. Intake of meat increased, and intake of green and yellow vegetables decreased. In fact, the obesity rate in the prefecture has become the highest in all of Japan. It’s likely that the traditional diet has played far more of a role in the Okinawans’ long lives than anything in their lifestyle and environment. Longevity Checklist: Okinawa Calorie restriction/fasting: Okinawans practice deliberate calorie restriction with Hari Hachi Bu. mTOR: The diets are low in animal protein. Tea/coffee/wine: Okinawans, like other Japanese, drink lots of tea. Salt: The meals are generally high in salt because of miso, kombu, and soy sauce. Fat: Fish is a staple of the diet, which is not high in fat, but low grains means a proper omega-6 to omega-3 ratio. No vegetable oils.
Sardinia, Italy On the other side of the world from Okinawa is the Italian gem of Sardinia, which was the first Blue Zone to be identified. Sardinia lies in the Western Mediterranean basin 75 miles off the coast of Italy. Because of its mountainous terrain, residents have mostly lived in extreme isolation and relative poverty. Most of its centenarians reside in tiny villages dotted throughout the isolated inland of the island. At one point, one out of every 200 people in the small town of Ogliastra had made it past the century mark.7 That’s about fifty times the rate at which people in the United States reach 100 years old. Of further interest, the rate of centenarians has an unusually low female-to-male ratio of 2:1 rather than the typical 5:1 of other Blue Zones.8 In Sardinia, the men were living past 100 years of age at a far greater rate than anywhere else in the world.
The first reliable accounts of the Sardinian diet come from French geographer Maurice Le Lannou, who described the diet as “remarkably frugal,”9 which was likely due to the poverty of the region. One staple was vegetable soup (minestrone) that included copious amounts of fresh, locally grown vegetables. Cooks often added pulses to these soups, which people often ate with sourdough bread. Chestnuts and walnuts provided a substantial source of calories and monounsaturated fatty acids. Residents ate meat infrequently, as you might expect in an impoverished region. Reports from the mid-nineteenth century suggest that Sardinians ate meat only two to four times per month, although this rate has steadily increased over the years. Nevertheless, an estimated 70 to 83 percent of dietary protein came from vegetables even until the mid-twentieth century. Dairy consumption, however, was much higher than meat consumption, especially among the shepherds on the island. They mostly drank goat and sheep milk, and they ate ricotta cheese. Only people in the coastal regions ate fish. The Sardinians, like their Italian cousins, drank a reasonable amount of wine, mostly red, averaging about 0.5 liters per person per week (or about one glass per day). The Cannonau grapes native to that region produce more red pigment, which contributes to the battle against harsh UV rays. During wine production, the grapes are allowed to macerate longer than for other wines. The pigment and the maceration time result in two to three times greater levels of flavonoids than other wines. The Sardinian diet, which includes a fair amount of cheese and some meat, looks nothing like the traditional Okinawan one, which is centered around sweet potatoes. Still, they make the cheese with milk from grass-fed sheep, and they often reserved the meat only for special occasions; hence, the overall diet is fairly low in meat. In general, meals are accompanied by plenty of whole-grain bread, beans, vegetables, and (almost always) a glass of red wine. These are, of course, the hallmarks of the oft-exalted Mediterranean diet. Longevity Checklist: Sardinia
Calorie restriction/fasting: Sardinians have “frugal” diets. mTOR: The diets are low in animal protein with emphasis on vegetables and legumes. Tea/coffee/wine: Like most Italians, they drink plenty of red wine. Salt: They have high sodium intake from milk and cheese. Fat: They eat lots of chestnuts and walnuts, which are high in monounsaturated fats. The diet is higher in dairy fats.
Loma Linda, California Loma Linda, California, which is just 60 miles east of the sprawling metropolis of Los Angeles, is an unlikely place to find one of the world’s highest rates of longevity. Its residents, who live as much as a decade longer than the average American, largely belong to the Seventh-day Adventist Church, a theology that recommends vegetarianism and abstinence from smoking and alcohol. Loma Linda University, operated by the Seventh-day Adventist Church, first began its study of the dietary and lifestyle habits of close to 25,000 residents in 1960. The original study, the Adventist Mortality Study (1960 to 1965), showed a significantly lower rate of cancer and heart disease compared to non-Adventists in the United States, which translated into a